Florida Department of Children and Families



SOUTHEAST FLORIDA BEHAVIORAL HEALTH NETWORK

ENHANCEMENT PLAN

FY 19/20

Mission Statement

The mission of the Southeast Florida Behavioral Health Network, Inc. (SEFBHN) is to develop, support, and manage an integrated network of behavioral health services to promote the emotional and mental well-being and drug-free living of children and adults in Indian River, Martin, Okeechobee, Palm Beach and St. Lucie Counties.

FY 19/20 Enhancement Plan

Introduction

In 2016 the Florida Legislature passed Senate Bill 12, which amended Florida Statute 394 related to Managing Entity Duties to include the development of annual Enhancement Plans with the initial plan to be submitted September 1, 2017. These plans are to identify 3-5 priority needs in the network service area and strategies for implementation of said needs. The following serves as Southeast Florida Behavioral Health Network’s (SEFBHN) Enhancement Plan for Fiscal Year 2019/2020. The Enhancement Plans supports our philosophy for a seamless, accessible, recovery-oriented system of behavioral health care. This is accomplished by ensuring a full array of prevention and treatment practices are available within our 5 county network that includes Indian River, Martin, Okeechobee, Palm Beach and St. Lucie.

It is important to note that the priorities identified in the initial Enhancement Plan submitted in 2017 were the result of a very comprehensive needs assessment conducted within our network that included input from stakeholder, providers and consumers. Following the results of the needs assessment, the Ronik-Radlauer Group – the consulting firm contracted to complete the assessment, facilitated a session in which stakeholders and consumer advocacy organizations were invited to review the data and identify service needs for priority populations. The results were drilled down to determine the common needs identifies across the network. The needs assessment also identified the overarching goals that should provide the framework as to how all services should be delivered – Trauma Informed, Culturally Sensitive, and Responsive. While we were not surprised that the assessment demonstrated needs across the continuum of care, SEFBHN has prioritized for the Enhancement Plan, services that will essentially serve to maintain consumers in the community which also aligns with the states initiative to implement a Recovery Oriented System of Care. SEFBHN has determined that the following continue to be enduring priorities within our community as we await the completion of the 2019 Triennial Needs Assessment. The updated assessment will ultimately assist in determining if any adjustments should be made to this Enhancement Plan as we continue in to FY 19/20. The Enhancement Plan for FY 19/20 as currently submitted serves to underscore these ongoing needs.

Priority 1 – An Additional FACT Team for Palm Beach County and an increase in the Reimbursement Rates for all existing FACT Teams in the Network.

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

As noted in the introduction to the Enhancement Plan, SEFBHN was able to conduct a comprehensive Behavioral Health Needs Assessment of our five county network in 2017 through a grant from the Farris Foundation combined with funding identified by SEFBHN. The Ronik-Radlauer Group was hired to conduct the assessment. The process for conducting the needs assessment included opportunities for public participation through key stakeholder interviews, focus groups, and surveys and while we are in the process of updating the Needs Assessment the information obtained in 2017 is still relevant. An additional FACT Team was and continues to be identified as a priority within our network community. It has also been identified that the reimbursement rate for existing and any new FACT Teams should be increased as there has not been a rate increase for FACT Team services since 2010.

Please describe:

a. The problem or unmet need that this funding will address

FACT Teams are an effective evidence-based service that provides multidisciplinary services to consumers with SMI. The intense level of services allows the consumer to live in the community in the least restrictive setting. An additional FACT Team will reduce the number of consumers who qualify from entering the SMHTF or conversely will increase the ability to provide appropriate discharge plans for consumers deemed ready for release from a SMHTF or other residential setting. An increase in the overall reimbursement rate will assist providers in retaining qualified staff which ultimately supports and enhanced continuity of care for the FACT Team participants.

b. The proposed strategy and specific services to be provided

FACT Team Services

c. Target population to be served

Adults with SMI and Co-occurring Disorders

d. County(ies) to be served (County is defined as county of residence of service recipients)

Palm Beach – for a new team

Palm Beach, Indian River, Martin, Okeechobee, St. Lucie for rate increases

e. Number of individuals to be served

100 for new team

300 for existing teams receiving a rate increase

2. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

3. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

4. Identify expected beneficial results and outcomes associated with addressing this unmet need.

Additional FACT Team availability will result in reduced use of costly high-end residential care. Carisk Partners who handles invoicing and data management for SEFBHN had previously completed a cost analysis for SEFBHN, on the return on Investment of FACT Teams to demonstrate the financial benefits of FACT Teams. The costs for FACT Team consumers were compared to costs for the top 100 utilizers at the time of the cost analysis. The average cost per FACT Team consumer was $3090.00 and the average cost for the top 100 utilizers was $15,527.00. Many of the costs associated with the Top 100 Utilizers are for intensive inpatient services, so while there is an obvious cost savings benefit - it is further augmented by maintaining individuals with serious mental illness in the community. The rate increase would increase the cost per consumer but the sense of autonomy that a FACT Team participant realizes living in the community with the potential for obtaining employment is immeasurable.

5. What specific measures will be used to document performance data for the project

The measures that will be used are outlined in the DCF Guidance 16 – FACT Handbook

Priority 2 – Forensic Services

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

2. As noted in the introduction to the Enhancement Plan, SEFBHN was able to conduct a comprehensive Behavioral Health Needs Assessment of our five county network in 2017 through a grant from the Farris Foundation combined with funding identified by SEFBHN. The Ronik-Radlauer Group was hired to conduct the assessment. The process for conducting the needs assessment included opportunities for public participation through key stakeholder interviews, focus groups, and surveys and while we are in the process of updating the Needs Assessment the information obtained in 2017 is still relevant. We continue to identify as a priority, the need to increase the capacity of Forensic Services which in essence entails a full array of behavioral health services for individuals involved in the criminal justice system at the pre-commitment and post-commitment level.

Please describe:

a. The problem or unmet need that this funding will address

A primary responsibility of Forensic services is coordinating the inpatient and outpatient placements of adults and juveniles either prior to their adjudication and commitment or upon discharge from a facility after the adult or juvenile has been adjudicated. In order to stabilize these individuals in the community a service plan outlining the array of services needed must be developed and put into place. The types of services that are utilized are psychosocial rehabilitation, anger management, mental health and substance abuse awareness and treatment, medication and relapse prevention, and vocational training. SEFBHN forensic providers have found it challenging to meet the needs of this growing number of forensic involved individuals. There are currently 5 staff working with the forensic population within our network. SEFBHN is also one of two out of seven Managing Entities that does not have a Community Forensic Multidisciplinary Team for State Hospital Diversion which is part of the continuum of forensic services. Additional funding for forensic services will allow for more concentrated efforts in coordinating care and to provide evaluation and treatment to all individuals in the least restrictive manner possible, ensuring the safety of the people we serve, and the community.

The proposed strategy and specific services to be provided

The strategy to address this need includes:

• Hiring a dedicated Competency Restoration educator using a standardized curriculum: outpatient and jail based: increasing frequency at each mental health center

• Hiring one Managing Entity Forensic Coordinator for Circuits 15 + 19 to include some Housing Specialist duties, and assist with applying for grants

• Hire three fully funded FTE Forensic Specialists for the three mental health centers

• Forensic beds: Residential Level 1 or Short-term Residential Treatment (SRT)

• Hiring a SOAR Specialist assigned to forensic cases only

• Hiring 5 Peer Specialists to be assigned to each Mental Health court  

• The establishment of 2 Community Forensic Multidisciplinary Teams for State Hospital Diversion to serve the most complex forensic involved individuals who would be admitted to the state hospital without this service in place. These teams are comprised of a specialized group of six (6) practioners with expertise in housing, justice system compliance, and recovery supports for a caseload of 45. This team will also ensure access to 24/7 crisis support, as-needed psychiatric care, and individual counseling. The goals include diverting individuals to community-based care when appropriate; lessening the debilitating symptoms of mental illness; addressing co-occurring disorders; reducing state hospitalization; supporting stable living environments; and collaborating with the criminal justice system to minimize incarcerations.

b. Target population to be served

Adults and Adolescents adjudicated as an adult identified by the criminal justice system as needing forensic services

c. County(ies) to be served (County is defined as county of residence of service recipients)

Indian River, Martin, Okeechobee, Palm Beach, and St Lucie

d. Number of individuals to be served

• Consumers to be served by the additional Forensic Care Coordinators:

75 forensic consumers

• Consumers to be served by the Community Forensic Multidisciplinary Team for Hospital Diversion:

90 forensic consumers

• Consumers to be served by Peer Specialists

100 mental health court forensic consumers

• Consumers to be served by SOAR Specialists

Expectation is to serve as many Forensic Consumers that are in need of benefits

• Forensic Bed Capacity

12 beds = 12,365 bed days

3. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

4. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

5. Identify expected beneficial results and outcomes associated with addressing this unmet need.

This expansion of Forensic Services to our network will allow for more concentrated efforts in coordinating care and providing services necessary to divert the forensic consumer from admission to the state hospital, ensuring the safety of the people we serve, and the community.

6. What specific measures will be used to document performance data for the project

The following measures will be used:

• Adults with forensic involvement who live in stable housing

• Adults with forensic involvement who do reoffend while receiving services

• Adults with forensic involvement who do not require admission to the State Hospital

Priority 3 – Increased Administrative funding for the Managing Entity Budget

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

Additional responsibilities continue to be assigned to the Managing Entity without additional administrative budget needed to affectively implement and administer them. The current administrative operating budget (OCA: MHS00) has consistently remained less than 5% of the total budget and continues so, as a result of an additional $5,229,000.00 dollars added to the direct services budget and no additional administrative funding.

Additional responsibilities and initiatives have and continue to include:

• Additional Family Intensive Treatment Teams (600 thousand)

• Assignment of two CAT Team contracts (1.5 million)

• Assignment of a Transitional Housing Program Contract (1.3 million)

• Assignment of the Navigate Program – First Episode of Psychosis (750 thousand)

• The Recovery Oriented System of Care (ROSC) Initiative – a major paradigm shift that requires training and additional consultation with providers to implement. (no additional funding for this effort)

• Adminstration of the Transitional Voucher Program

The assignment of new contracts and addition of new programs impact all staff with additional training for providers, contracting responsibilities, data surveillance, and on-site contract validation reviews.

Please describe:

a. The problem or unmet need that this funding will address

The problem is addressed in question 1.

The ME Administrative Cost should minimally be adjusted to become 5% of the Direct Care Budget:

ME Administration OCA: MHS00

ME Operational Integrity to provide funding to manage increased program responsibilities

An increase of $948,314.00 for a total of $3,341,659.00

b. The proposed strategy and specific services to be provided

The funding will eliminate barriers to effectively administer programs receiving both state and federal funding.

c. Target population to be served

Children and Adult Mental Health

Children and Adult Substance Abuse

d. County(ies) to be served (County is defined as county of residence of service recipients)

Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie

e. Number of individuals to be served

The additional funding for Administrative Costs essentially enables quality driven essential oversight of providers serving all vulnerable consumers in our network

2. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

3. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

4. Identify expected beneficial results and outcomes associated with addressing this unmet need.

Ability to maintain and preferably increase services from FY 18/19 levels

Increased ability to provide support and oversight to subcontracted providers

Ensure that priority populations are served appropriately

Retain qualified staff within the Managing Entity

5. What specific measures will be used to document performance data for the project

All standard outcome measures within our contract with DCF would apply to this priority.

Priority 4 – Increased Access to Psychiatric Services

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

As noted in the introduction to the Enhancement Plan, SEFBHN was able to conduct a comprehensive Behavioral Health Needs Assessment of our five county network in 2017 through a grant from the Farris Foundation combined with funding identified by SEFBHN. The Ronik-Radlauer Group was hired to conduct the assessment. The process for conducting the needs assessment included opportunities for public participation through key stakeholder interviews, focus groups, and surveys and while we are in the process of updating the Needs Assessment the information obtained in 2017 is still relevant. Increased access to psychiatric services continues to be a priority within our network.

2. Please describe:

a. The problem or unmet need that this funding will address

Psychiatric services including medication management are a critical aspect of behavioral health services. As part of an overall treatment plan psychotropic medications are very effective at stabilizing individuals, allowing them to remain integrated within the larger community – living independently and maintaining employment. Our network providers have expressed concerns that they do not have enough psychiatrists and that due to the shortage the increased workload makes it difficult to maintain the ones they do have. Monitoring psychotropic medications is a fine balancing act – blood work is required, dosages may need to be adjusted or the actual medication may need to be changed. Limited access to psychiatric services to provide the level of monitoring needed can result in decompensation and the consumer may have to be admitted to a crisis stabilization unit. These types of crisis may also result in the individual losing their employment and possibly their housing if they are unable to pay their rent. Increased access to psychiatric services will allow for a crisis to be averted before it occurs.

b. The proposed strategy and specific services to be provided

Hiring the equivalent of 2.5 part-time psychiatrists and contracting with a telemedicine services company for psychiatric care for up to 40 hours a week.

c. Target population to be served

Adults with SMI and Co-Occurring Disorders

Children with SED and ED

d. County(ies) to be served (County is defined as county of residence of service recipients)

Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie

e. Number of individuals to be served

1800 - 2000

3. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

4. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

5. Identify expected beneficial results and outcomes associated with addressing this unmet need.

Greater access to psychiatric services will allow the consumer more time to explain their symptoms to the psychiatrist who in turn will also have more time to accurately diagnose the consumer and prescribe the most appropriate medicines at the lowest doses. The consumer is stabilized reducing the need for interim appointments, and inpatient crisis stabilization placements and the psychiatrists have more time to treat additional consumers.

6. What specific measures will be used to document performance data for the project

The standard contract measures will be utilized:

• Employment of adults with SMI

• Adult with SMI who live in stable housing

• Percent of school days Children with SED and ED attended

• Children with SED and ED who improve their level of functioning

SEFBHN will also be monitoring these consumers to determine if there is a decrease in admissions to the CSU

Priority 5 – Supportive Housing

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

As noted in the introduction to the Enhancement Plan, SEFBHN was able to conduct a comprehensive Behavioral Health Needs Assessment of our five county network in 2017 through a grant from the Farris Foundation combined with funding identified by SEFBHN. The Ronik-Radlauer Group was hired to conduct the assessment. The process for conducting the needs assessment included opportunities for public participation through key stakeholder interviews, focus groups, and surveys and while we are in the process of updating the Needs Assessment the information obtained in 2017 is still relevant. Increased Supportive Housing continues to be a priority within our network.

2. Please describe:

a. The problem or unmet need that this funding will address

One of the biggest issues many individuals with mental illness face is the availability of housing. The cascading effects of mental illness might leave them in a precarious housing situation, or even cause them to lose their homes. Having a safe and secure place to live is an important part of recovery, along with access to services that enable those with mental health conditions to live as independently as possible.

Stable housing is also a critical component in the journey toward recovery for individuals with substance use disorders. SEFBHN has been making concerted efforts to deal with the Opioid Crisis with the use of Medication Assisted Treatment (MAT). For individuals whose treatment can be managed on an outpatient basis, stable housing is key to maintaining contact with the consumer during the early stages of MAT.

The lack of affordable housing contributes to individuals utilizing more restrictive placements as a default such as jails and crisis stabilization units, residential mental health and substance abuse treatment and it can hinder the ability to transition an individual with SMI out of the State Mental Health Treatment Facilities (SMHTF). Having a mental health condition or a substance use disorder can make finding and keeping a home challenging. If you are poor, renting an apartment may be beyond your means.

b. The proposed strategy and specific services to be provided

SEFBHN proposes to contract for the delivery of Supportive Housing Services for individuals with SMI and co-occurring disorders. The services provided would include:

1) Transitional setting with 6 beds. The individuals would be living independently, paying their own room and board but have access to a supportive living coach and be offered life skill and independent living training. The provider will also assist the residents of the home/apartment in applying for SOAR benefits, and food stamps and in identifying other resources in the community such as public transportation or supportive employment services. They also tend to have access to 24-hour crisis support services, although these services may not be available onsite. This level of supportive housing is intended to be transitional – allowing individuals a safe stable setting while they learn needed skills to eventually live in community-based housing.

2) An additional component is for these same Supportive Housing Services as noted in item (1), but for individuals who are already living on their own or looking to transition to a more independent setting (i.e. the adult who has been living with family but who want to or needs to find their own living arrangement).

3) An increase in funding for transitional housing vouchers for individuals with Substance use disorder – used primarily for 1-3 months rent in a FARR certified Recovery Residence for individuals beginning MAT.

c. Target population to be served

Adults with SMI, and Co-occurring Disorders,

Adults with substance disorders

d. County(ies) to be served (County is defined as county of residence of service recipients)

Primarily St. Lucie County but the non-transitional component of the Supported Housing services would be available in Indian River, Martin, and Okeechobee Counties

The transitional housing vouchers will be utilized in Indian River, Martin, Okeechobee, Palm Beach and St. Lucie Counties.

e. Number of individuals to be served

100 for transitional housing

40 for transitional housing vouchers.

3. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

4. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

5. Identify expected beneficial results and outcomes associated with addressing this unmet need.

• Supportive Housing is consistent with the principles of the Recovery Oriented System of Care in that is can result in:

• Reduction in the use of more restrictive placements (i.e. jail, CSU’s and SMHTF’s)

• Sustained Recovery for consumers receiving these services

• Increase in the consumers receiving these services living independently

6. What specific measures will be used to document performance data for the project

The standard contract measures will be utilized to include

• Adults with SMI living in stable housing

• Reduction in number of adults arrested

• Adults with Co-Occurring disorders who live in stable housing

• Adults who successfully complete Substance Abuse Treatment

Priority 6 – Integration of Primary and Behavioral Health Care

1. Please describe the process by which the area(s) of priority were determined. What activities were conducted, who participated, etc.

As noted in the introduction to the Enhancement Plan, SEFBHN was able to conduct a comprehensive Behavioral Health Needs Assessment of our five county network in 2017 through a grant from the Farris Foundation combined with funding identified by SEFBHN. The Ronik-Radlauer Group was hired to conduct the assessment. The process for conducting the needs assessment included opportunities for public participation through key stakeholder interviews, focus groups, and surveys and while we are in the process of updating the Needs Assessment the information obtained in 2017 is still relevant. Integration of Primary and Behavioral Health Care continues to be a priority within our network.

2. Please describe:

a. The problem or unmet need that this funding will address

Many consumers who receive services through the publicly funded providers are often faced with other challenges such as little or no income, minimal access to transportation, food insecurity and limited familial or other social supports. These challenges then contribute to their ability to access a full continuum of health care services and ultimately their ability to maintain a state of wellness.

Failure to recognize and appropriately treat behavioral health conditions has a significant impact on health outcomes and costs: patients with these diagnoses use more medical resources, are more likely to be hospitalized for medical conditions, and are readmitted to the hospital more frequently.  Some of these patterns are reflected in an analysis commissioned by the American Psychiatric Association (APA) that found spending for patients with comorbid mental health or substance abuse problems is 2.5 to 3.5 times higher than for those without such problems—with the vast majority of spending going to general medical services, not behavioral health.

Integrated primary/behavioral health care has the potential to improve health outcomes for patients and health care delivery within practices. “Behavioral Health integration is the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.” This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization. 

b. The proposed strategy and specific services to be provided

Piloting a fully integrated Primary/Behavioral Health Care Clinic.

Understanding that this is a process that will not happen overnight and in turn will require a great deal of planning and working with community stakeholders and providers, SEFBHN is proposing to hire a consultant with expertise in this area. The consultant would be responsible for bringing the key stakeholders together to develop a plan and the strategies needed to open a truly integrated Primary/Behavioral Health Care Clinic. This will include identification of a community within the network to locate the clinic and the budget needed to run it. While state funding would be used to support the clinic, other sources of funding such as Medicaid and local funding will be required also. As noted in previous submittal of our enhancement plans the funding request for this fiscal year is for the consultant’s fees.

c. Target population to be served

Children with SED and ED

Adults with SMI, and Co-occurring Disorders,

Adults and youth with substance disorders

d. County(ies) to be served (County is defined as county of residence of service recipients)

One piloted location within the 5-county network to be determined by planning process

e. Number of individuals to be served

1500. month

3. Please describe in detail the action steps to implement the strategy

See attached excel workbook- action plan tab

4. Identify the total amount of State funds requested to address the unmet need and provide a brief budget narrative. Please identify any other sources of state and county funding that will contribute to the proposal.

See attached excel workbook- budget tab

5. Identify expected beneficial results and outcomes associated with addressing this unmet need.

A truly integrated primary/behavioral health care clinic will lead to improved care and reduced costs as health problems will be identified at earlier stages when they are less expensive to treat and the integrated care will increase the health care provider’s ability to identify the root cause of the illness.

6. What specific measures will be used to document performance data for the project

The standard contract measures will be utilized to include

• Employment of adults with SMI

• Adults with SMI and substance abuse disorders who live in stable housing

• Percent of school days Children with SED and ED attended

• Children with SED and ED who improve their level of functioning

• Adults and children successfully completing substance abuse treatment

Additional measures will be developed to track individual health status of consumers served and the cost savings for both primary care and behavioral health care.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download